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Reproductive Endocrinology

MON-128 - Mining Pre-Eclampsia Biomarker Associations for Improved sFlt-1/PlGF Ratio Performance

Monday, June 15, 2026
9:00 AM - 2:00 PM CT
Disclosure(s):
Hannah Hooker, MSc: No financial relationships to disclose


Background: The ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) is increasingly used in the assessment of suspected pre-eclampsia, a hypertensive disorder of pregnancy and a leading cause of maternal and perinatal morbidity and mortality. Combining angiogenic markers with routinely measured biochemical and clinical parameters may further enhance diagnostic performance. This study aimed to explore associations between the sFlt-1/PlGF ratio and other biomarkers relevant to pre-eclampsia using novel Siemens sFlt-1 and PlGF Atellica® assays.

Methods: Initially the study compared the analytical and clinical performance of the novel Siemens sFlt-1 and PlGF Atellica® assays with the NICE-approved Roche Elecsys® assay. This included a retrospective, multi-centre UK study across six NHS laboratories comparing immunoassays for sFlt-1 and PlGF in pre-eclampsia diagnosis. Retrospective serum samples (n=60) with a range of sFlt-1/PlGF values and known clinical outcomes were obtained from symptomatic patients investigated for suspected pre-eclampsia. Direct method comparison between Elecsys® and Atellica® assays was carried out using Passing-Bablok regression and Bland–Altman analysis. Spearman’s rank correlation coefficients (rho) were calculated to assess relationships between the sFlt-1/PlGF ratio, routine biomarkers and ultrasound fetal measurements. Correlation matrices underwent complete linkage hierarchical clustering to identify groups of similarly correlated biomarkers. Both linear and non-linear relationships between biomarker pairs were explored.

Results: Method comparison identified a positive bias of the Atellica® ratios compared to the Elecsys®, suggesting a need to adjust rule-in/out cut-offs to maintain equivalent clinical decision thresholds. The sFlt-1/PlGF ratio (measured by either assay platform) showed a strong positive correlation with serum urate (r > 0.7) and a moderate correlation with urine protein:creatinine ratio (r = 0.4). An inverse relationship between sFlt-1 and PlGF was observed across the full spectrum of ratios. Exploratory analyses of urate versus sFlt-1/PlGF ratio identified potential for improved classification of patients investigated for pre-eclampsia. Correlation coefficients and clustering patterns of biomarkers were highly consistent between the assay platforms.

Conclusions: The diagnostic accuracy and clinical utility of the Siemens sFlt-1 and PlGF Atellica® assays appear comparable to the NICE-approved Elecsys® assays, supporting their use as an alternative for pre-eclampsia diagnosis. Assay-independent associations between the sFlt-1/PlGF ratio and other biomarkers, particularly serum urate, suggest that integrating additional biomarkers in data science algorithm-based approaches may enhance clinical performance and diagnostic accuracy.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*